[Cancer of the cervical esophagus: integrated therapy and surgical treatment]

From July 1979 to December 1990, 68 consecutive patients with resectable esophageal cancer were treated at our Institute. Until May 85 standard treatment was total laryngectomy and proximal or total esophagectomy, thereafter, to preserve the larynx, primary concomitant chemotherapy and radiotherapy followed by salvage resection in case of persistent disease or local recurrence was the standard regimen. Primary concomitant radio-chemotherapy consisted of traditional radiotherapy (30 + 20 Gy over 7 weeks) with 4 courses of chemotherapy (5FU 1000 mg/sqm 24-hour infusion, days 1 to 4 and CDDP 100 mg/sqm, day 1). 39 patients underwent standard primary total laryngo-pharyngo-esophagectomy, and after May 1985, 29 underwent standard concomitant radiochemotherapy and 16 excluded patients (5 for medical contraindications, 4 for previous partial or total laryngectomy, and the remaining 7 for location of the tumor only in the precricoid) underwent primary resection as second choice treatment. After 40 months of median follow-up 6/39 underwent salvage resection. Iatrogenic mortality (hospital and distant mortality related to the treatment) was 10% (9/68), 13% (5/39) for standard and second choice primary resection and 10% (3/29) for concomitant radiochemotherapy (2 death) and salvage resection (1 death). For overall the patients the median survival was 16 months, without any difference for the patients treated before or after May 85, with minimal difference of the rate of 5 year survival (21% vs 19%), but nearly 50% of the long survivors treated after May 85 is speaking with the larynx.